ROBERT B. BRIGHAM MULTIPURPOSE ARTHRITIS CENTER

申请这笔赠款是为了开发三个特别感兴趣的领域。第一 是应用研究，我们的目标是：1)开发一个必要和充分的 为关节炎患者合理规划卫生服务的数据库，以及2) 开发和评估具有成本效益的医疗保健提供的模式组成部分 关节炎患者。因此，在社区组成部分下，我们建议制定和 严格评估：七天的康复工作时间表；模范健康 关节炎残疾护理系统；加强康复服务，以 待在家里的病人；风湿病患者的随访系统 从三级护理机构出院；以病人为中心的改善策略 临床结果；以及低血压初级预防的教育策略 工作场所的背部受伤。作为四大关节置换术之一 ，我们建议对联合中心的成本效益进行评估 取而代之的是多层面的成果评估。我们试图记录下 关节炎患者的经济负担和目前卫生保健的不足 报销方案。我们建议评估干预措施的手段 可以通过比较现有健康状况的相对优劣来进行评估 功能性仪器。第二个优先事项是发展一个核心单位 关于定量研究方法、临床流行病学和评估 研究，这将与中心的许多活动重叠，并有助于 对调查人员进行培训和建立调查人员。该股将 从特殊疾病的日常管理中支持至少10个项目 旨在改进临床策略的临床研究注册和 风湿病的决策和基础研究的应用。最后， 我们建议在一个被忽视的研究领域进行试点研究，即管理 所有常规治疗均失败的严重类风湿性关节炎患者： 因此，处理对总节点的关键评估的协议 放射疗法和白细胞清除法治疗难治性类风湿性关节炎。

This grant is requested to develop three areas of special interest. The first is applied research in which we aim to: 1) develop a necessary and sufficient data base for the rational planning of health services to arthritics, and 2) develop and evaluate model components of cost-effective health care delivery for arthritis patients. Thus under Community Component, we propose to develop and critically evaluate: a seven-day rehabilitation work schedule; a model health care system for arthritis disability; stepped-up rehabilitation services to homebound patients; a system of followup of rheumatic disease patients discharged from a tertiary care facility; a patient-oriented strategy to improve clinical outcomes; and an educational strategy for the primary prevention of low back injuries in the work place. As one of the 4 major joint replacement centers in the world, we propose to evaluate the cost-effectiveness of joint replacement by a multi-dimensional outcome assessment. We seek to document the economic burden to arthritics and shortfalls in the present health care reimbursement scheme. We propose to evaluate the means by which interventions can be evaluated by comparing the relative merits of existing health status functional instruments. The second priority is the development of a Core Unit for quantitative research methods, Clinical Epidemiology and Evaluation Research, which would overlap with many activities of the Center and would aid investigators in training and establishing investigators. The Unit would support at least 10 projects from the day-to-day management of special disease registries to clinical studies directed at improving clinical strategies and decision making in rheumatology, and applications of basic research. Finally, we propose pilot studies in a neglected area of research, the management of severe rheumatoid arthritis patients who have failed all conventional therapy: thus, the protocols addressing the critical evaluation of total nodal irradiation therapy and leukapheresis therapy of refectory rheumatoid arthritis.